Solar term peak of onset and death in 1 597 patients with acute ischemic stroke Circular statistical analysis

BACKGROUND： Previously, time data were analyzed by using constituent ratio or relative ratio; however, circular statistical analysis could exactly provide average peak phase of diseases. OBJECTIVE： To investigate the correlation of solar term peak with onset and death of acute ischemic stroke. DESIGN： Retrospective case analysis. SETTINGS： Emergency Department of Foshan Municipal Hospital of Traditional Chinese Medicine; Department of Science and Education, the Second People＇s Hospital of Foshan. PARTICIPANTS： A total of 1 597 patients with acute ischemic stroke were selected from Emergency Room, Department of Neurology, Foshan Municipal Hospital of Traditional Chinese Medicine from 1994 to 2002. There were 875 males and 722 females, and their ages ranged from 33 to 97 years. All cases met the diagnostic criteria of acute cerebral infarction modified by the Second National Cerebrovascular Disease Academic Meeting; meanwhile, they were diagnosed with CT/MRI test. Patients and their relatives provided the confirmed consent. METHODS： Solar term of onset was retrospectively analyzed in 1 597 patients with acute ischemic stroke; among them, solar term of death in 90 cases were analyzed by using circular statistical analysis to calculate peak phase of onset and death of acute ischemic stroke and investigate the correlation of solar term with onset and death of acute ischemic stroke. MAIN OUTCOME MEASURES： Onset and death time of patients with acute ischemic stroke. RESULTS： Solar term of onset in 1 597 patients, especially solar term of death in 90 patients, was not concentrated （P 〉 0.05）, and specific peak phase was not found out. Acute ischemic stroke low attacked from vernal equinox to summer begins, but death caused by acute ischemic stroke high attacked from grain buds to autumn begins. CONCLUSION： Patients with acute ischemic stroke do not have specific solar term peak of onset and death.     

Validation of the Bech–Rafaelsen Melancholia Scale and the Hamilton Depression Scale in patients with major depression; is the total score a valid measure of illness severity?

OBJECTIVE: Evaluation of antidepressant drug efficacy requires adequate rating scales for measuring the severity of depression. However, to measure the illness severity by such a total score, the scale needs to fulfil criteria of unidimensionality. On this background, we aimed at comparing the unidimensionality of the Bech-Rafaelsen Melancholia Scale (MES) and the 17-item Hamilton Depression Rating Scale (HAM-D(17)). METHOD: A total of 1629 patients aged between 18 and 65 years with a major depressive episode were treated openly with sertraline at a fixed oral dose of 50 mg daily during 4 weeks. The HAM-D(17) and the MES were applied at baseline and at weeks 2 and 4. Unidimensionality was tested with Mokken and Rasch analysis. RESULTS: Unidimensionality of the HAM-D(17) could not be confirmed. However, the 6-item Hamilton Depression Subscale (HAM-D(6)), was accepted by the Rasch analysis both at baseline and after 2 and 4 weeks of therapy. For the MES (as well as for the HAM-D(6)), a Loevinger coefficient of homogeneity above 0.40 (suggesting acceptance) was found at week 4. CONCLUSION: The HAM-D(6) and the MES did fulfil criteria for unidimensionality while the HAM-D(17) did not. Therefore, the extended use of the HAM-D(17) in drug trials may be questioned.     

Association of monocyte chemoattractant protein-1 −2518A>G polymorphism with occurrence, severity, and outcome in ischemic stroke

Monocyte chemoattractant protein-1 (MCP-1) is implicated in promoting atherosclerotic diseases, including stroke. Therefore, several studies have investigated the association between variants of the MCP-1 gene and risk of atherosclerotic diseases. We sought to determine the occurrence of MCP-1 ?2518A>G polymorphism in patients with ischemic stroke (IS), and studied its association with the severity of disease and functional outcome after an acute IS. One hundred and forty-five consecutive patients with first ever IS and 145 age- and sex-matched control subjects were recruited. Stroke severity and functional outcome were assessed on admission and at one month post-stroke, respectively. Genotyping for the MCP-1 ?2518A>G polymorphism was performed by a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). No significant difference in the frequency of MCP-1 ?2518A>G genotypes between IS patients and controls was found, with OR = 0.69 (95 % CI 0.46–1.04, P = 0.08). Moreover, carriage of the G allele was not associated with stroke severity (Scandinavian stroke scale score 33.1 vs. 32.5, respectively, P = 0.71), or poor outcome at 1 month post-stroke (63.9 vs. 59.7 %, respectively, P = 0.61). In conclusion, we were unable to demonstrate a significant association of the MCP-1 ?2518A>G gene polymorphism with IS occurrence, severity or functional outcome in a Caucasian population. However, larger studies are necessary to fully elucidate the role of this polymorphism in IS.     

Evaluation of anhedonia with the Snaith–Hamilton Pleasure Scale (SHAPS) in adult outpatients with major depressive disorder

Anhedonia or inability to experience pleasure not only is a core symptom of major depressive disorder (MDD), but also is identified as an important component of the positive valence system in the NIMH Research Domain Criteria. The Snaith–Hamilton Pleasure Scale (SHAPS) has been developed for the assessment of hedonic experience or positive valence, but has not been well-studied in depressed outpatient populations.The current study examined the reliability and validity of the SHAPS using a sample of adult outpatients with treatment resistant MDD. Data for the current study were obtained from 122 adult outpatients with a diagnosis of MDD and non-response to adequate treatment with an SSRI and who participated in Project TReatment with Exercise Augmentation for Depression (TREAD). A Principal Components Analysis was used to define the dimensionality of the SHAPS. Convergent and discriminant validity were evaluated via correlations of the SHAPS total score with “gold standard” measures of depression severity and quality of life. The SHAPS was found to have high internal consistency (Cronbach's coefficient α = .82). A Principal Components Analysis suggests that the SHAPS is mainly “unidimensional” and limited to hedonic experience among adult outpatients with MDD. Convergent and discriminant validity were assessed by examining the Spearman rank-order correlation coefficient between the SHAPS total score and the HRSD₁₇ (r_s = 0.22, p < .03), IDS-C₃₀ (r_s = 0.26, p < .01), IDS-SR₃₀ (r_s = 0.23, p < .02), QIDS-C₁₆ (r_s = 0.22, p < .03), QIDS-SR₁₆ (r_s = 0.17, p < .10), QLES-Q (r_s = −0.32, p < .002), and the pleasure/enjoyment item (sub-item 21) of the IDS-C (r_s = 0.44, p < .0001) and IDS-SR (r_s = 0.38, p < .0002). The self-administered SHAPS showed modest sensitivity (76%) and specificity (54%) with the self-administered pleasure/enjoyment single item (sub-item 21) of IDS-SR₃₀. The current study shows that the SHAPS is a reliable and valid instrument to assess hedonic experience or positive valence in adult outpatients with MDD and provides a broader assessment of this important domain.     

Headache as a symptom at stroke onset in 4,431 young ischaemic stroke patients. Results from the “stroke in young fabry patients (SIFAP1) study”

Headache as symptom of stroke is linked to gender, history of migraine, younger age, cerebellar stroke, and low blood pressure. These associations have been controversial, large scale studies are missing. We used the stroke in young fabry patients study to examine the association of demographic, clinical and imaging factors with the occurrence of headache in 4,431 young ischaemic stroke patients (18–55 years; mean: 44.7 years) with an ischemic cerebrovascular event (CVE) (ischemic stroke—IS 75.9 %, TIA 24.1 %). Headache in males occurred more frequently in bilateral localisation (right/left/bilateral: 27.5, 24.6, 39.2 %, p < 0.01), but not in females (40.3, 34.7, 39.6 %). Headache occurrence was more often associated in both genders with IS or TIA in the posterior cerebral territory (male: 33.2 %, p < 0.05; female: 51.0 %, p < 0.01) and vertebrobasilar arteries (male: 44.8 %, p < 0.001; female: 51.2 %, p < 0.001). The larger the size of the most prominent lesion the more likely patients were complaining headache during the IS (≤1 cm vs. >half lobe: 19.5 vs. 28.4 % in male, p < 0.001; 28.9 vs. 39.1 % in female, p < 0.01). Binary logistic regression analyses revealed lower age (p < 0.001), female sex (p < 0.001), larger size of the largest lesion (p < 0.001), and localization in the vertebrobasilar territory (p < 0.001) as predictors for headache during CVE. Headache at stroke onset is more common during IS in females, younger patients, with greater size of the acute lesion, and affected in posterior cerebral artery or vertebrobasilar system. Headache is a leading symptom in specific combination of stroke factors. These factors should be taken into account when patients report headache during IS or TIA.     

Study of a group of extremely preterm infants (25-27 weeks): how do they function at 1 year of age?

The functional outcome of 49 extremely preterm infants (gestational age: 25-27 weeks) was studied at the corrected age of 12 months. Apart from pediatric follow-up, a full neurologic assessment and the Bayley Motor and Mental Scales of Infant Development was done. Emphasis was placed on postural control, spontaneous motility, hand function, and elicited infantile reactions. Special attention was given to symmetric development. The infants were then categorized as having optimal or nonoptimal or asymmetric outcome. Overall, an optimal outcome was found in 19 infants (39%) and nonoptimal outcome in 30 infants (61%), 7 of whom failed on all domains of function. Postural control had a significant influence on the different domains of development such as motility (P < or = .001) and persistent infantile reactions (P < or = .001) and slightly less on hand function (P = .08) and asymmetry (P = .06). The outcome on spontaneous motility was significantly related to the results on infantile reactions (P < or = 005) and hand function (P = .05). Also, the score on the motor scale of the Bayley Developmental test was clearly related to outcome on spontaneous motility (P < or = .001) and reactions (P< or = .02). Abnormal brain ultrasonograms were related to the asymmetry of the infantile reactions (P < or = .05). Poor coordination of gross motor function will have consequences for appropriate visuomotor and sensorimotor integration, thereby hampering motor learning and later cognitive function, as is often described in preterm infants. It is suggested that the poor postural control found in many infants born preterm is the result of both myogenic and neurogenic deviations caused by the preterm birth and its nursing consequences.     

Diabetic neuropathy in patients with “Latent Autoimmune Diabetes of the Adults” (LADA) compared with patients with type 1 and type 2 diabetes

OBJECTIVE: In previous studies, a lower incidence of diabetes-related complications such as diabetic neuropathy has been reported in patients with early stages of type 1 diabetes compared with type 2 diabetes. The aim of this study was to compare the prevalence of diabetic neuropathy in patients with manifestation of a slow onset type 1 diabetes in adulthood - latent autoimmune diabetes in adults (LADA) - with classical type 1 and type 2 diabetes patients. RESEARCH DESIGN AND METHODS: Altogether, 37 patients (14 LADA, 9 type 1 and 14 type 2 diabetes) with short term diabetes (duration < 5 years) were investigated for diabetic neuropathy on the basis of clinical and neuroelectrophysiological evaluations. The neurological functions were evaluated by a standardized questionnaire and clinical examination. In electrophysiological evaluations the different nerve fibres were investigated using motor and sensory nerve conduction studies, quantitative thermotesting, vibratometry and autonomic function tests (heart rate variability). RESULTS: LADA patients had a significantly lower clinical examination score (p = 0.008), cardiorespiratory reflex index (p = 0.009) and cold perception threshold index (p = 0.004). The neurological symptom score, the indices of motor and sensory nerve conduction, the index of thermotesting (warm perception threshold) and the vibratometry showed a trend to higher values in LADA patients than in type 2 diabetes patients. There were no significant differences between LADA and type 1 diabetes patients. CONCLUSIONS: LADA patients had fewer features of diabetic neuropathy than type 2 diabetes patients in the early stages of disease, thus being more similar to classical type 1 diabetes patients who normally develop diabetic neuropathy rather late.     

Clinical utility of the Wechsler Memory Scale — Fourth Edition (WMS-IV) in patients with intractable temporal lobe epilepsy

IntroductionThe Wechsler Memory Scale (WMS) is one of the most widely used test batteries to assess memory functions in patients with brain dysfunctions of different etiologies. This study examined the clinical validation of the Dutch Wechsler Memory Scale — Fourth Edition (WMS-IV-NL) in patients with temporal lobe epilepsy (TLE).MethodThe sample consisted of 75 patients with intractable TLE, who were eligible for epilepsy surgery, and 77 demographically matched healthy controls. All participants were examined with the WMS-IV-NL.ResultsPatients with TLE performed significantly worse than healthy controls on all WMS-IV-NL indices and subtests (p < .01), with the exception of the Visual Working Memory Index including its contributing subtests, as well as the subtests Logical Memory I, Verbal Paired Associates I, and Designs II. In addition, patients with mesiotemporal abnormalities performed significantly worse than patients with lateral temporal abnormalities on the subtests Logical Memory I and Designs II and all the indices (p < .05), with the exception of the Auditory Memory Index and Visual Working Memory Index. Patients with either a left or a right temporal focus performed equally on all WMS-IV-NL indices and subtests (F(15, 50) = .70, p = .78), as well as the Auditory–Visual discrepancy score (t(64) = − 1.40, p = .17).ConclusionThe WMS-IV-NL is capable of detecting memory problems in patients with TLE, indicating that it is a sufficiently valid memory battery. Furthermore, the findings support previous research showing that the WMS-IV has limited value in identifying material-specific memory deficits in presurgical patients with TLE.     

Improvement of health-related quality of life in relapsing remitting multiple sclerosis patients after 2 years of treatment with intramuscular interferon-beta-1a

In patients with relapsing remitting multiple sclerosis (RRMS), the effect of interferon-beta (INFb) on health-related quality of life (HR-QoL) is not firmly documented. The objective of this study is to assess HR-QoL during 2 years of treatment with intramuscular INFb and its correlation with disability. In 36 neurological practices in the Netherlands (17), Belgium (16), United Kingdom (2) and Luxemburg (1), 284 RRMS patients were treated with intramuscular INFb-1a. Physical and mental domains of HR-QoL were measured by the MS54 Quality of Life (MS54QoL) questionnaire, and disability was assessed by the Multiple Sclerosis Functional Composite (MSFC) (Timed 25-Foot Walk Test [Timed 25-FWT], 9 Hole Peg Test [9-HPT], Paced Auditory Serial Addition Test [PASAT]) at baseline and at months 3, 6, 12, 18 and 24. Expanded Disability Status Scale (EDSS) score was assessed at baseline and month 24. Pearson’s correlation coefficients were determined and predefined factors were analyzed for relation to HR-QoL after baseline by stepwise regression analyses on physical and mental scores. 204 patients (71.8%) completed 2 years of treatment. Mean values for MS54QoL increased from 56.6 to 61.0 for physical (p < 0.05) and from 57.2 to 61.1 for mental domain (p = 0.07). Correlations between physical domain and MSFC was −0.40 (p < 0.05), and between mental domain and MSFC −0.24 (p < 0.05). MSFC and EDSS did not change. Increase of physical MS54QoL was associated with lower age, lower EDSS, less time for Timed 25-FWT, and higher PASAT score at baseline. Increase of mental MS54QoL was associated with higher PASAT and lower EDSS. Patients who discontinued INFb had lower physical or mental HR-QoL at baseline. In RRMS patients, 2 years of treatment with intramuscular INFb-1a is associated with an increase in HR-QoL, especially in younger patients with low disability.     

The expression of angiotensin-converting enzyme 2–angiotensin-(1–7)–Mas receptor axis are upregulated after acute cerebral ischemic stroke in rats

There is now unequivocal evidence that the angiotensin-converting enzyme 2(ACE2)–Ang-(1–7)–Mas axis is a key component of the renin–angiotensin system (RAS) cascade, which is closely correlated with ischemic insult occurrence. Our previous studies demonstrated that the Ang-(1–7), was an active member of the brain RAS. However, the ACE2–Ang-(1–7)–Mas axis expression after cerebral ischemic injury are currently unclear. In the present study, we investigated the time course of ACE2–Ang-(1–7) and Mas receptor expression in the acute stage of cerebral ischemic stroke. The content of Ang-(1–7) in ischemic tissues and blood serum was measured by specific EIA kits. Real-time PCR and western blot were used to determine messenger RNA (mRNA) and protein levels of the ACE2 and Mas. The cerebral ischemic lesion resulted in a significant increase of regional cerebral and circulating Ang-(1–7) at 6–48 h compared with sham operation group following focal ischemic stroke (12 h: 7.276 ± 0.320 ng/ml vs. 2.466 ± 0.410 ng/ml, serum; 1.024 ± 0.056 ng/mg vs. 0.499 ± 0.032, brain) (P < 0.05). Both ACE2 and Mas expression were markedly enhanced compared to the control in the ischemic tissues (P < 0.05). Mas immunopositive neurons were also seen stronger expression in the ischemic cortex (19.167 ± 2.858 vs. 7.833 ± 2.483) (P < 0.05). The evidence collected in our present study will indicate that, ACE2–Ang-(1–7)–Mas axis are upregulated after acute ischemic stroke and would play a pivotal role in the regulation of acute neuron injury in ischemic cerebrovascular diseases.     

Glasgow Coma Scale ≤ 12 at Admission is a Predictor of Poor Functional Outcome (mRS 2–6) at One Year in Patients with Cerebral Venous Thrombosis

ObjectiveTo determine factors at hospitalization of cerebral venous thrombosis (CVT) which determine outcome at one year.MethodsThis was an ambispective study with outcome at one year follow up. Patients angiographically proven as CVT were included in study and functional modified Rankin Scale (mRS) determined at one year. They were dichotomized into “good” outcome (mRS 0–1) and “poor” outcome (mRS 2–6). Variables at admission were compared on univariate and then by cox proportional hazard regression for significance. Complications during follow up period were also compared.ResultsOne hundred and seventy five patients were included, data of 71 was collected prospectively. One hundred and seventeen (66.9%) had “good” outcome while 58 (33.1%) had “poor” outcome. Univariate analysis showed poor outcome associated with age < 30 years, female sex, focal deficit, GCS ≤ 12, ≥3 sinuses involved and intracerebral haemorrhage. On Cox proportional hazard regression only GCS ≤ 12 was significant. Around 96% had complete/ partial recanalization at 6 months. Over one year, the complications included dural AV fistula in 10 (5.7%), intracranial hypertension in 4 (2.3%), venous thromboembolism in 6 (3.4%) and arterial infarct in 4 (2.3%). Proportions with complications in each group were similar. At one year 41 patients (25.2%) were continued on anticoagulation and 97 (55.2%) on antiepileptic drugs. Proportion in each group were similar.ConclusionIn patients with CVT, GCS ≤ 12 at admission was a predictor of poor functional outcome (mRS 2–6) at one year. During this period, complications were few and similar in the both the groups.     

Prevalence of positive syphilis serology and meningovascular neurosyphilis in patients admitted with stroke and TIA from a culturally diverse population (2005–09)

The study aims were to determine the prevalence of positive syphilis serology and meningovascular neurosyphilis (NS) in patients admitted with transient ischaemic attack (TIA) and stroke to a tertiary hospital serving a culturally diverse community. A retrospective cohort analysis was conducted using routinely collected administrative data and medical records to identify patients admitted with TIA, stroke and other conditions, with positive syphilis serology, between 2005 and 2009. Direct medical record review confirmed diagnoses of meningovascular NS. Syphilis serology was requested in 27% (893/3270) of all patients with TIA and stroke (2005–09) of whom 4% (38/893) were positive. Thirty-seven patients with positive serology had clinical characteristics consistent with meningovascular NS. Their mean age was 72 ± 13 years; 65% were male and 68% had a recorded place of birth in South-East Asia or the Pacific Islands. One of 12 patients with suspected meningovascular NS with cerebrospinal fluid (CSF) analysis had a positive CSF Venereal Disease Research Laboratory (VDRL) test. Three patients (8%) met diagnostic criteria for “definite or probable” meningovascular NS. All three patients with a “definite or probable” meningovascular NS and 15 (44%) of the remainder who had positive serology without confirmation of NS were treated with intravenous or intramuscular penicillin. Lumbar puncture (LP) and penicillin were underutilised in patients with TIA and stroke with positive serology. In conclusion, syphilis testing should be considered part of the diagnostic work-up of TIA and stroke, particularly in ethnically diverse populations. In patients with TIA and stroke with positive syphilis serology, it would seem appropriate to further pursue diagnosis and treatment and in patients unable to undergo LP, empiric treatment for NS should be considered.